Kidane Michael Tewolde

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

061805 Issued in NY

Practice address

462 Grider St
Buffalo, NY 14215-3021

Phone

(716) 898-1736

NPI assigned

Mar 27, 2020

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Ecmc Foundation Inc

  • Skilled Nursing Facility
  • Buffalo, NY
  • NPI 1427686427
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1585267200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1695081600000",
    "number": "1811525827",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6 WALLING AVE",
            "city": "ONEONTA",
            "state": "NY",
            "postal_code": "138201916",
            "telephone_number": "607-437-1041"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "462 GRIDER ST",
            "city": "BUFFALO",
            "state": "NY",
            "postal_code": "142153021",
            "telephone_number": "716-898-1736"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TEWOLDE",
        "first_name": "KIDANE",
        "middle_name": "MICHAEL",
        "name_prefix": "Dr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-03-27",
        "last_updated": "2023-09-19",
        "certification_date": "2023-09-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NY",
            "license": "061805",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Valerie Testa
• Kristin Tetrault, RN
• Andrew Marc Tetro, M.D.
• Josette Anna Teuscher, MD
• Angela Tewa
• Rahul Kumar Thakur, M.D.
• Sumangaly Thambiaiyah, M.D.
• Kannan Thanikachalam, M.B.B.S.
• Krishnakumar Thankappan, MBBS
• Aung Ko Ko Thant, M.D.

• General Practice Dentistry in Buffalo, NY
• Providers in Buffalo, NY by specialty
• General Practice Dentistry in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.